Articles and Research

Big Traumas, Little Traumas: A New Psychotherapy Technique Can Help with Both
by Janice DeLange, Ph.D.


Capital T traumas, small t traumas.

The big ones are easy to recognize: assault, physical and sexual abuse, car accidents, death or suicide of a loved one, or serious illness; they frequently result in Post Traumatic Stress Disorder (PTSD). The small ones often are repetitive negative events: receiving frequent criticism or blame; being called names; or feeling frequently humiliated or embarrassed as a child, and still remembering this as an adult. Eye Movement Desensitization Reprocessing (EMDR), is a relatively new psychotherapy technique for working with, and overcoming, traumatic memories--both large, and small. 

Whether a given situation is experienced as traumatic depends on the individual. One person may have a bad car accident, yet continue driving without a qualm, while another becomes phobic or suffers from anxiety behind the wheel. Events experienced as traumatic create upsetting memories that can have lasting negative effects on the way a person views the world or relates to others. A certain sound, smell, or sight can trigger the same fear and anxiety experienced during the original situation. 

Jim, for example, a war veteran who has been back in the U.S. for years, continues to suffer from nightmares and flashbacks. He has trouble driving down a highway at night because the headlights of oncoming cars flash him back to when he stood at a checkpoint and didn't know whether an oncoming vehicle was friend or foe, life or death for him and his men.

George also suffers from PTSD. He survived an accident that claimed the life or a young driver who ran a stop sign, and now reacts with fear at cars approaching from his left, can no longer drive through the fatal intersection without extreme anxiety, and is startled by every bump in the road.



 Susan, too, finds her life clouded by traumatic memories. She grew up with a critical, strict father, and now reacts with anxiety whenever her supervisor calls her into his office, expecting to be criticized for doing something wrong--all because she carries a core negative belief that she cannot do anything right.
 
In circumstances like these, using EMDR can help overcome traumatic memories, so that the person no longer relives the anxiety-producing images, sounds, and feelings when the event is brought to mind. The event is still remembered--but without the upsetting emotions.

The actual process of EMDR follows a standardized protocol. A client calls to mind a disturbing event, and the thoughts and feelings that it arouses (for a few seconds to a couple of minutes), while the therapist facilitates directional eye movements to bilaterally stimulate the brain. This may involve alternating hand tapping, or sounds moving from side to side. It is thought that the brain then reprocesses the recalled memories in such a way that the traumatic event ceases to arouse such disturbing thoughts and feelings. Each person processes the information in their own unique way; there is no such thing as doing it "wrong." The process of EMDR is interspersed with debriefing and talking about what comes up. 

How EMDR works--neurobiologically or in the brain--is not yet fully understood; studies are ongoing. We do know that when people are upset, the brain processes information differently. EMDR appears to be similar to what occurs naturally during dreaming, or REM (rapid eye movement) sleep.

A number of scientific studies (Bradley, R. et al, 2005; Davidson, P.R. et al, 2001) have shown that EMDR is effective for PTSD and that its beneficial effect is maintained. The International Society for Traumatic Stress Studies recognizes EMDR as an effective technique for dealing with trauma. The American Psychological Association, the U.S. Department of Veterans Affairs, and the U.S. Department of Defense have rated EMDR in the highest category for effectiveness. Many EMDR therapists have found it helpful for clients with anxiety, panic attacks, phobias, complicated grief, disturbing memories or performance anxiety, and for survivors of sexual and/or physical abuse.

Since EMDR is a psychotherapy technique, sessions are often covered through health insurance. EMDR often works more rapidly than many other types of psychotherapy, a plus for managed care insurance plans where the number of sessions is limited. It is usually combined with talk therapy.

Capital T, small t--traumatic memories of either size can cripple us emotionally, and even cause distressing physical symptoms. EMDR offers new hope, and effective results.

References:

Bradley, R., Greene, J., Russ, E., Dutra, L., and Westen, D. (2005). A multi-dimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227.

Davidson, P.R., and Parker, K.C.H. (2001). Eye Movement desensitization and reprocessing (EMDR); A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.